A groundbreaking ceremony recently marked the beginning of construction on the new forensic hospital on Western State Hospital’s campus in Lakewood, Washington. Read More …
All posts tagged “Evidence-Based Design”
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From Sterile to Serene: Design that Humanizes Behavioral Healthcare
According to the Bureau of Labor Statistics, the need for behavioral health is not slowing down anytime soon — projecting it will grow 22% by 2031. At the same time, healthcare systems are realizing the importance of design to address aging facilities and ensure that the next generation of behavioral health facilities prioritizes the well-being and comfort of patients, staff and the community — reducing stigma and prioritizing comfort for those who need it most.
The following are trending design considerations for behavioral health patient populations:
Adolescent and pediatric patients: When it comes to adolescent and pediatric patients, designing for different ability levels is crucial. Care for children exists on a spectrum, just as it does with adults. Providing activities for more acute and autonomous patients is vital in their treatment and care. This can be done by incorporating inclusive features, such as accessible musical instruments and sensory panels, which allow for freedom of play and a pleasant exercise in creativity.
Adult and geriatric patients: Adult and geriatric patients also need a balance of calm respite and activity space. Where you have independent play areas in the younger units, modern spaces in adult and geriatric units may have a small nook for reading, observing art in the landscape or an intentional view into the adjacent landscape. The addition of playful colors to surface materials (e.g., stained, or patterned concrete, poured-in-place rubber) or site furniture also helps enhance and activate the space. Exploring these material combinations, in collaboration with interior designers, can aid in wayfinding and bring a sense of whimsy without creating triggers or negative thoughts.
Specific design interventions for behavioral health staff
As the need for staff increases, tailored amenities contributing to reduced staff stress and absenteeism are becoming essential. The latest amenity trends include:
Adaptable site furniture: Gone are the hard, cold chairs one would expect to find in a behavioral health facility. Loungers in the sun and dining tables with moveable chairs give staff the options to have different experiences — to either be alone or socialize. In the staff-designated spaces, furnishings should be resilient, while delivering comfort and healing to those providing care.
Staff respite areas: Outdoor courtyards throughout the design of modern behavioral health centers should be designated for staff use only. These staff courtyards differ from patient courtyards and usually include a program of small dining and seating areas, elongated and uninterrupted views of nature and a mix of textures (both hardscape and softscape).
Lighting: Artificial light brightens dark spaces and ensures safety for staff and patients. Having adequate light is also vital for face recognition throughout these centers. Soft lighting in exterior staff spaces provides security while allowing for views of the night sky, minimizing light bleed into patient areas.
No live plant material indoors: Mental health professionals are busy caring for people, which is why the interior staff areas should be intentionally free of live plants, resulting in an inside area that is maintenance-free and maintainable in the short and long term for the client. Although it’s encouraged to refrain from living plants indoors, it’s also vital to work closely with architectural design partners to make sure the indoor clinical spaces take as many advantages as possible to connect to outdoor green spaces.
Landscape architecture design and planning can also help to de-institutionalize behavioral health facilities and encourage visitors and community members to use them. When behavioral health centers are designed with consideration for those who visit, they can become a resource for the community and act as a makerspace for all.
Specific design interventions for the community
Community events: When designed with aesthetics in mind, modern behavioral health centers can serve as a space for events. Such is the case for Permian Basin Behavioral Health Center, a unique project in West Texas. Community group rooms located within medical office buildings like PBBHC can open to an outdoor patio or event lawns to provide an alternative programmable space. These outdoor spaces allow for flexible-sized group events without feeling restricted, disturbing other facility functions or confining anyone to the limits of other intended-use interior rooms.
Outdoor areas and community spaces: In community outdoor areas, more traditional furniture pieces, planting and fence materials may be included — so that these spaces can be used not just by outpatient providers, but by the broader community through nonprofits, support groups or higher education groups. Design considerations include furniture types (e.g., moveable, lightweight, flexible use), durable finishes and exterior considerations for shade.
The face of healthcare is changing — for the better. Through Evidence-Based Design, tailored amenities transform even the starkest of spaces and create a feeling of support for all who enter. Thanks in part to thoughtful planning and an eye for detail, the design features, plantings and artistic elements featured in modern behavioral health settings go far beyond pure aesthetics to provide something even more important — a reminder to those within them that with proper care they, too can bloom.
Rendering courtesy of Dunaway
Rethinking Healthcare Design to Address Post-Pandemic Workforce Shortage
Addressing incentive factors, safety + cultural differences
When discussing healthcare design, the vernacular among architects and designers must revolve around the patient experience, healing environments and promoting healthier local communities. This familiar verse among healthcare professionals has positioned architects and design firms to create the next best healthcare facility by the formulations of Evidence-Based Design. Then came COVID-19, and the necessity for healthcare facilities to reinvent themselves throughout the pandemic.
The world has not been the same and neither has the healthcare workforce, which has been exhausted and burned out from facing COVID-19 since early 2020. As a result, the healthcare workforce crisis threatens organizations, while hospital employment continues to decline.
“Prioritizing design around the patient experience is no longer the only priority,” said Alta Hospitals CEO Dr. Hector Hernandez. “For the first time in my 30 years in healthcare administration, I have had to become extra creative by finding ways to retain nursing and clinical ancillary staff. This has included additional breakrooms, Zen-type meditation rooms and spaces to provide pet therapy for employees and physicians, while enhancing cafeteria services that operate 24/7. Design cannot be ignored because it now accounts for what nurses and staff are looking for when joining Alta Hospitals.”
Martin Luther King Jr. Community Hospital. Photo by: David Wakely Photography
What does this ultimately mean for healthcare designers? The following key insights on catering designs to attract healthcare staff have been garnered over the last few years:
Accounting for healthcare workforce incentive factor
More than ever, designing support areas for healthcare providers — such as staff lounges, staff dining facilities and physician on-call rooms, among other spaces — must be closely analyzed and programmatically defined to account for the healthcare workforce incentive factor.
When Los Angeles County board of supervisors Mark Ridley-Thomas, who oversaw construction of the new Martin Luther King Jr. Community Hospital, asked HMC to design the building, part of his request was that “the people from South Los Angeles should feel they were getting the same quality building as the people of Beverly Hills.”
The hospital was to be run by a newly formed operator, MLK Healthcare Corp, leasing the facility from the county of Los Angeles. Thus, the entire hospital staff was to be hired anew, beginning with the CEO. It was considered a challenge to attract high-quality staff to South Los Angeles, a portion of the city some saw as a less desirable workplace.
When the project was under construction, the MLK Healthcare Corp advertised 600 positions and was elated to receive 3,000 applications from people who worked at places like Ronald Reagan UCLA Medical Center, Cedars Sinai and UC Irvine Medical Center. Applicants explained they felt drawn to the mission of MLK Community Hospital to serve the underserved, and they felt the beautiful new campus buildings and interiors would be a wonderful place to work.
Clovis Community Medical Center’s phase C expansion. Photo by: Lawrence Anderson Photography
Supporting those who care for patients
In another example, Clovis Community Medical Center’s phase C expansion included a significant expansion of 11 projects to double the campus’ beds and emergency, diagnostic, treatment and support capacity. Since Clovis is in Central California, and had an inadequate medical workforce to meet the needs of this and other projects in the growing community, it became necessary to attract medical staff, including traveling nurses from different parts of California and other states, to staff the newly expanded hospital and provide the care needed and projected by the community’s growth. The hospital was able to hire the staff more quickly than anticipated, with many applicants stating the Clovis Community Medical Center campus was the most attractive and pleasant option in the region.
The new inpatient care tower and outpatient treatment center and support building not only take into consideration what the design means for patient care, but also how it supports those who care for the patients. While staff safety is crucial, analyzing what that means on the other side of the pandemic has reactivated design efforts into a checklist of items.
Focusing on sustainability, staff safety + mental health
The Design-Build team of Hensel Phelps | HMC Architects | CO Architects is leading the design and construction of Harbor UCLA Medical Center’s replacement campus. Design tasks include analyzing how not only to best reflect high-quality patient care, but also how the design supports staff.
For example, patient-and-staff interaction hubs, such as check-in and registration areas, are designed with aesthetic precaution. Desking must include privacy panels, while other areas are divided with transaction glass windows where color and graphics help soothe environments. Taming design to care for patient privacy, as well as account for enhanced staff protection, has meant rethinking space-planning layouts where social distance is layered and preferred. Waiting areas where tandem seating once allowed for maximizing occupancy loads are now becoming dispersed to account for safety vs. overcrowding.
In addition to supporting enhanced patient care and operational and sustainable efficiency, the Design-Build team’s efforts with Harbor-UCLA address the importance of employee mental health. While the project aims for LEED Gold certification, ensuring sustainability goals are met throughout the campus program results in strong efforts to support employee wellness and reduce burnout and turnover.
Aesthetically, the design incorporates the surrounding environment. Local textures and colors of the harbor and calm local South Bay are reminiscent through material textures and curved finishes. Biophilic design concepts are used throughout; expanded visibility of the native landscape and natural light that seeps into the main lobby and other employee and patient areas allow staff and visitors to reset and restore mentally.
Adapting to cultural, generational differences
Alta’s Hernandez recommends focusing on spaces dictated by the local labor force and younger generations, but emphasizes how it is crucial to address diversity, equity and inclusion for the thousands of nurses and healthcare professionals coming from countries such as the Philippines, India, Canada and Mexico, among others. Their cultural differences must be addressed for better adaptation and cultural transgression issues related to their relocation to the United States.
Designing to accommodate tech
According to YM Careers Network, one of many recruiting organizations connecting millennials and Gen-Z healthcare talent with healthcare systems, it is essential to have modern, tech-friendly systems in place to attract today’s candidates. It’s important to design technology systems that support staff communication and efficiency, such as remote interview areas, intentional kiosk locations within hospitals and mobile-friendly interfaces and communication, all of which serve as part of the recipe for a tech-friendly recruitment approach.
For designers, this means heightening knowledge of how we view and design around technology and cultural barriers. Design for the healthcare professional coming from another country and cultural background must account for religion, gender identification and ethnicity to make them feel welcomed and diminish possible barriers.
For instance, designing around technology to support staff communication and operating efficiencies means keeping an outlook for future technological needs and paying attention to how future healthcare talent will approach technology. This means not designing wall niches for queuing monitors or televisions in public waiting areas, as we’ve been used to, because we don’t know what the future holds for queuing system technologies or if a television of a specific display size will continue to serve an entire waiting area.
Designing for future generations
So, what does this all mean for healthcare designers and architects acclimating to this new healthcare era?
The answer is simple. Designing in post-pandemic times requires addressing not only the immediate urgencies that will mitigate a dwindled workforce, but continuing to design for future generations, while not overlooking a tune-up of the true healthcare engine — the healthcare workforce.
Rethinking the Design of Cancer Care Facilities
Adopting integrated, EBD approach improves delivery of care
Historically, cancer care has been siloed in a healthcare delivery setting, requiring patients to see oncologists, radiologists and surgeons separately, often in varying areas of a facility or another building entirely. Today, these three disciplines work together and meet weekly, sometimes daily, to consult on treatment plans — allowing cancer care delivery to become more integrated under one roof.
While co-location of services is nothing new, moving patients to different points of care has shifted to moving the care to the patient. This has provided new context for facility design as architects and designers are now designing for not only cancer care, but the ever-expanding group of subspecialties that accompany it. In this continuum of care delivery model, practitioners share the same clinical and support spaces. Therefore, it’s important to build spaces that continue to prioritize mainstays in cancer care design, focus on reducing stress in the patient experience and include universal design strategies and adaptable, flexible environments.
Over the next decade, the Centers for Disease Control expects a 20% increase in cancer cases, generally due to the aging population, underscoring the criticality of well-designed facilities that support this paradigm shift in care delivery.
Adopting an integrated approach to care delivery
Generally, architects and designers work to design facilities that best support care delivery, considering operational necessities, the treatment itself and its effect on patients and how physicians and patients interact.
Today, there are many different components to cancer care that are critical, including clinical, imaging services, telehealth services, research, labs, clinical trials, cancer patient-specific urgent care, palliative care and survivorship, among others. The integrated approach combines these services with standard treatments under the umbrella of oncology, radiology and surgery, allowing physicians to work cohesively with case management, for the betterment of the patient.
With the integrated approach comes adjustments to the physical treatment spaces. Designers must create spaces which allow each subspecialty to exist and operate in harmony by combining all services together, not just co-located in a single building. For example, a consult room may be a space within the exam room to support the ability to bring administration services to the bedside.
Taking cues from healthcare practices with Evidence-Based Design
Evidence-Based Design is a common method in the design of healthcare facilities, derived from the practice of evidence-based care, which drives medical and care delivery decisions based on research. EBD utilizes research that links the human condition to the physical environment and considers which environmental factors can best support operations and the wellness of the patient, aid in the reduction of medical errors, improve patient safety and improve overall patient outcomes.
The implementation of EBD can promote healing and improve patient outcomes in a variety of ways, and can be categorized by the potential benefit; reducing stress, preventing injury, reducing errors, supporting operations and supporting staff. There are several research-based ways to reduce patient stress and promote a sense of well-being, and in cancer care, it manifests in many ways, but particularly in the human brain and the body’s innate connection to nature. Many aspects of cancer care facilities are rooted in biophilia, prioritizing access to sunlight, fresh air, views of nature and live plants, which can have a positive impact on patient recovery. To prevent injury, patient lifts and non-slip flooring may be installed. To prevent infection, providing hand-washing sinks for staff, installing HEPA filters and the separation of clean and dirty material flows are critical. To best support staff, reducing travel distances and providing staff respite spaces are particularly important.
Prioritizing the patient experience
Cancer can be a fast-acting and grueling disease, and can affect patients differently, resulting in a spectrum of symptoms and abilities. For this reason, designers must prioritize the patient experience and be cognizant of the ways in which it should accommodate patients’ differing needs.
To cater to the spectrum of patient needs, it is important to provide a variety of spaces and conditions, particularly for infusion pods. Patients, depending on symptoms and illness, will have preferences on where they receive infusions, so cancer care facilities should consist of a range of environments to optimize comfort for each patient. While some patients may relish the opportunity to take in sunlight, others may require darkness for sleep and rest. Some may be interested in socializing with other patients, while others may prefer a more quiet, private space. Other variables include duration of stay and mobility.
As patients going through chemotherapy may have cognitive impairment to some degree, as well as limited walking abilities, wayfinding is an important aspect of cancer care design. Due to the large and complex nature of hospitals, they can often have unclear signage, confusing hallways and difficult-to-navigate parking, which can instill unnecessary stress on patients and contribute to a longer healing process. To combat this, cancer care facilities require clear and natural wayfinding tools. Providing patient drop-offs and reception areas within line of sight from the front door is the first step for minimizing confusion.
A well-designed wayfinding system incorporates signage in conjunction with strong visual clues through the use of color, pattern and texture to direct patients to different departments and areas of the building. When possible, eliminating navigation altogether can offer a solution by making it possible for subspecialties to travel to the patient or offer telehealth appointments. While patient recovery is based on many factors, designers should be aware of the ways in which facility design can help negate stressors that could lengthen a patient’s recovery period.
Continuing to improve cancer care facilities
With the development of new imaging technologies, novel therapies, use of AI, expansion of clinical trials and more complex pathology labs, the cancer center must continue to evolve. Evidence-based strategies for prevention, early detection, diagnosis, treatment and palliation have expanded to include more robust patient support services including case management, connection to cancer care networks and family support services. Resulting from this desire to provide holistic patient care, cancer centers are starting to incorporate family spaces. There is much to learn about cancer as a disease and the treatments used to fight it, and families are often in search of education materials. Moving forward, waiting room areas will be more of a continuum, with educational touchpoints becoming increasingly integrated into the experience.
Oncology emergency departments are also on the rise to provide a more calm, less crowded and easy to access environment. These EDs are separate from a hospital setting and catered to cancer patients and their specific symptoms, simplifying the approach to EDs as much as possible.
While it is difficult to predict medical advances that may affect facility design in the future, these innovations in cancer care facility design are changing the landscape for the better.
Photos courtesy of NELSON Worldwide
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